Early and accurate diagnosis and treatment of nipple–areolar complex (NAC) ischemia and necrosis are fundamental to the practice of breast surgery. Knowledge of breast anatomy, risk factors, and proper technique is not sufficient for avoiding this complication in all cases. Management of this situation is dynamic; it depends on the time of detection, and knowledge of different surgical maneuvers for NAC reperfusion. Management of this complication will continue to improve with technologic advances and research.
Key points
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The anatomy of breast circulation as a key element to prevent nipple–areolar complex (NAC) ischemia and necrosis.
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Ischemia detection during the operative procedure to enable reperfusion maneuvers is important.
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Reperfusion techniques are described as essential to revert NAC sufferance.
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NAC grafting as last option in salvage attempt, and as primary indication.
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NAC reconstruction with different techniques and with synthetic materials is described.
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